1550

THE LANCET.

LONDON: SATURDAY, JUNE S, 1012.

HOSPITAL SUNDAY IN LONDON.

Hospital Sunday in London."THE KING and QUEEN will attend the 10.30 morning

service at St. Paul’s Cathedral on Hospital Sunday, June 9th,"runs the announcement made officially in the newspapers,and the information must have been read with satisfaction

by all who have at heart the prosperity of the MetropolitanHospital Sunday Fund. They must have felt the confident

hope that the example set by Their Majesties would befollowed widely, and that loyal subjects throughout London,and in all places of worship where collections are made onbehalf of the Fund, would support by their presence, by their

recruiting enterprise, and by their purse a noble charitableeffort. Example is proverbially better than precept, and

King GEORGE and Queen MARY could have chosen no bettermethod for reminding us unostentatiously but unmistakablyof the goodwill which they, like those whose traditions theyinherit, have always shown towards the work done in the

hospitals, of their sympathy with the physical suffering oftheir humblest subjects, and of their knowledge of the

practical financial difficulties which hamper and restrain

the alleviation of that suffering. That the hospitals of

London should have won Their Majesties’ esteem and appro-bation is not to be wondered at. They are personallyfamiliar with many of the wards for which the MetropolitanHospital Sunday Fund makes its appeal. Their high positiongives them no privilege of immunity from illness, and theyshare the indebtedness of their subjects to surgical andmedical science. To recall prominent instances, they saw

King EDWARD VII., on the eve of his coronation, laid on

the bed of sickness and restored to health by an

operation which would not have been possible in those

earlier days of his life, when as PRINCE of WALES he lay atdeath’s door through typhoid fever; while they know thaton that momentous occasion it was, under divine providence,the prescience and assiduous care of physicians- and nurseswhich enabled him to win through in a hand-to-hand battlewith death. They have lived to see that dreaded diseasecombated by new methods which deprive it of half its terrors.

King GEORGE and his spouse have recently returned from the

great ceremony of the Durbar and from a triumphant progressacross their Indian Empire, where even more conspicuouslythan at home scientific investigation is arresting and banish-

ing or rendering comparatively innocuous scourges once

looked upon as inexorable and almost invariably conquer--ing enemies of human life. Their Majesties are fullyappreciative of the progress of medical and surgical science,and of the fact that the hospitals of London, on whoselehalf the Metropolitan Hospital Sunday Fund solicits thealms of the tenevolent, perform a paramount, share in

training those who fight death and sickness throughout the

empire.It is not, however, on account of the debt that the public

owe to the medical profession, or to the hospitals whichafford to the members of that profession their pricelesseducation, that the Metropolitan Hospital Sunday Fund holdsits annual collection with the active concurrence of our

KING and QUEEN, and with the hearty support and goodwillof their subjects. The hospitals of the metropolis are without,rivals in the world as a system of charitable institutions.

They are the free gift of those who have to those who havenot, carrying on a magnificent work without State or

municipal subvention, and on this great plea they taketheir stand. The donations of the living and the

bequests of our forefathers have made these institutions

what they are, but neither the quick nor the dead haveenabled them to attain to financial independence or to

approach within reasonable distance of so desirable a posi-tion. It is not, indeed, in the nature of their case that theyshould ever occupy it. An individual or an institution with

carefully defined ambitions may limit expenditure in accord-ance with an estimate of a more or less assured income rand in regard to an individual, if he decide to practiseeconomy, he can do so in most cases by denying benefits tohimself. But a hospital can only curtail its outlay at the

expense of the sick and suffering and by refusing to an

increasing throng of applicants that which it exists to.

supply-namely, the best of medical service. For these-

institutions-to whose doors the inmates flock from the

ever-growiDg County and City of London, to doors which

are not closed, even to those that come from further

afield-receive a crowd of patients which can never

grow less in volume in existing circumstances, while

it is not easy to contemplate conditions under which the

supply of beds would ever exceed the demand that science,.eugenics, and charity would alike consider proper. Further,.it must be remembered that as the scope of the service of

hospitals, especially of the in-patient service, grows larger,.so does the expense of that service mount with our ever-

spreading developments in the art of healing. The daydraws no nearer when the demand can cease for fresh

apparatus and equipment to carry out new measures for

saving life and for restoring to health those who rightlyclaim in the hospitals the best help that science can give.To go forward must ever be the aim of these great templesof our knowledge, these great centres of our activity. It is

essential to the existence of a hospital nowadays that it

should be in the best sense of a current expression"up-to-date"; it would show a poor gratitude to the

generous donors who support these institutions, and a

miserable inappreoiation of the hopes of those dead

friends from whom the endowments are drawn, if the hospitalwere not provided with all that is modern for the use ofthe humble patients, discarding that which is obsolete andadding that which after due trial is found to yield solidresults. The hospitals- can make due return to the charitablefor their benevolence in this way-by equipping with know-

ledge and skill nowhere else attainable those who devote

the best hours of their lives to working on behalf of the

poor in the wards, of a. hospital

1551HOSPITAL SUNDAY IN LONDON.

What the hospitals of London mean, and for genera-

tions have meant to the working poor of London, we need

hardly dwell upon at length. Those for whom life is

not a perpetual struggle, who can make provision againstthe onset of sickness or the misfortune of accident,whose wives and families have friends or relatives readyto assist them in time of stress,-those, though they may befar removed from higher circles of society, can but

faintly realise what happens when from injury or

disease the usually independent worker is thrown into

enforced idleness or finds himself nearing the brink of an

untimely grave. To him health means the power to keephimself alive by honourable toil and the chance to maintain

those dependent upon him. The charity which the hospitalaffords him may be, and probably is, the only eleemosynary.assistance that he has ever asked for or would ever

accept. He can take it without shame because that

which is thus placed within his reach is far beyondanything that any economy of his own could ever

provide, consisting of medical or surgical aid, such as

the urgency of his case demands, administered in those

circumstances of nursing, housing, and nourishment with-out which such aid would be ineffective. Address-

ing (as on the present annual occasion we are wont

to do) a public outside the usual circle of our medical

readers, and urging the claims of the great medical charitiesof London to their generous support, we would ask them tomake the present year 1912 memorable in the annals of the

Metropolitan Hospital Sunday Fund by increasing the

revenue of the Fund beyond any point to which it has

hitherto attained. The occasion is one favourable to the

making of a special effort. Last year the Coronation

may have distracted attention from the cause of the

hospitals. This year the London season is running its

course upon lines which must mean great profits to

many individuals and regular work to many operatives.The country is at peace with the world, despite the

rumours of war, and the returns of British trade show

advancing prosperity in the face of the grave unrest that is

prevalent in industrial circles. It would be wilfully’shutting our eyes to what is obvious it we ignoredthe causes for national anxiety, but there is nothingin our existing political and social situation which

should act other than as a keen stimulant to generosity. In

a period of unrest in the world of labour, such as now

prevails, there is always a danger lest some should feel alarmand seek to avoid a purely voluntary expenditure from

motives of economy. Others, again, in the same circum-stances may be influenced almost unconsciously by a senseof irritation at the loss which strikes and threatened strikes

impose upon commerce. We would ask them to remember

that the need of the poor in their time of sickness and injuryis ever the same. The poor cannot wait for medical or

surgical aid until "times are better"; and the hospitalcannot withdraw that aid at a moment’s notice in anticipa-tion of a diminished income.

Yet another cause which may tend to lessen the contribu-

tions of the benevolent on Hospital Sunday in the presentyear is the great calamity which is still fresh in thememories of us all. The unparalleled disaster to the

Titanic roused the nation to an open-handed outpouringof charity on behalf of the bereaved relatives of those who

perished. Of this generosity we may feel justly proud. We

claim, however, on behalf of the hospitals that the sup-port accorded annually to them through the medium of the

Metropolitan Hospital Sunday Fund should not be diminishedon that account. If any should be tempted to say to him-

self, 11 I have just given freely to help the widowed andorphaned; I cannot afford this year my usual contributionon Hospital Sanday," let him remember that to act thuswould make not him but a hospital, which needs every pennyit can get, a -contributor to the Titanic fund. We should

not, perhaps, have referred to this, trusting that publicgenerosity and thought for others would suggest the argu-ment we have used, if we were not credibly informed that insome quarters church offertories and other subscription listshave exhibited an appreciable falling off, attributed, not

without apparent j justice, to the cause suggested. The appealof the hospitals to the public is ever a reiteration of that

with which all ears are already familiar-it is a demand

which has little novelty upon which those who make

it may rely, and it is therefore at a disadvantage in

competing for popular attention with special funds startedto meet emergencies. One circumstance or another may

always tend to lessen the support accorded, and to

cause anxiety to those who realise the difficulty with whichthe yearly income is made to meet the yearly necessaryexpenditure.We are within a month or two of the coming into force

of a National Insurance Act which may some day exercisea potent effect in safeguarding the national health. With-

out discussing here the many causes which gravelythreaten the smoothness of the working of the machineryof this vast experimental measure, we would point out that itwould be little short of a national misfortune if the anticipa-tion of coming taxation, imposed with a view to secure medicaltreatment for the working classes such as the Act proposesto provide, should cripple the hospitals of London bydiminishing the gifts of their former generous supporters.Whatever benefits the Insurance Act may secure for the

poor in the future, it will not abolish their need for

treatment in hospitals ; it will not alter the fact that

only such aid as the hospitals afford will avail them

in many circumstances ; it cannot change the position of

the hospital as the agency which restores the worker to

health, which sends back the mother to her husband and her

children, and restores the child to his parents when noother method under our existing social scheme could workthese miracles. We urge upon all to follow the exampleset them by their KING and QUEEN who will attend

divine service in the Cathedral of the metropolis of their

empire on Hospital Sunday, and of the Lord Mayor of

London, who, with His Majesty’s judges, will be presentat the afternoon service on the same day. The tendencyof modern life in London, what is known as the " week-end

habit," and the popularity of various forms of amusement

have diminished the congregations of many places of

worship during recent years. We desire to enter uponno controversial topic, but we do entreat those who,in the pursuit of health and pleasure, are absent on

1552 THE MEDICAL FACTOR IN THE ITALO-TURKISH WAR.

Hospital Sunday from London not to forget the claims

of the Metropolitan Hospital Sunday Fund. We also

make the suggestion that if any would feel the blessing ofexercising self-denial in a worthy cause the opportunity is

present for their acceptance. The week-end expedition tothe country or the seaside, the long motor ride, and the gameof golf are not uncostly pleasures. To forego an act of self-

indulgence and to place the money saved in the collecting-bag, perhaps to double or treble it after reflection upon the

goodness of the cause of the Metropolitan Hospital SundayFund, would be a practical act of unselfish consideration forothers.

The Medical Factor in the Italo-Turkish War.

THE Army Medical Department is scoring a distinct

success in the otherwise unresplendent operations of the

Italian forces in North Africa. To the credit of that depart-ment, be it recorded, that scarcely had the invading armydisembarked when not only were ambulances, thoroughlyequipped and manned, established at the line of combat forthe care and cure of the wounded, but an equally well-

appointed service was set on foot in the interests of the

native tribes, decimated as these are by septic disease affect-ing mainly the organs of special sense and the aural and

naso-laryngeal passages. At Tripoli, to begin with, in an

unfrequented street, there is the Ambulatorio Baccelli,so-called after the Nestor of Italian medicine, open everymorning at 9, when its doors are thronged by a crowd ofArabs eagerly expectant of relief or cure. The institution is

divided into four branches, set apart for the specialtreatment of indigenous maladies, of which syphilis and

ophthalmia are the chief. The prevalence of syphiliticinfection, which has never been subjected to skilled

treatment and is as often congenital as acquired, is

appalling. Ophthalmia is almost universal among the

natives, even the upper classes suffering severely from

it, oftener than not accompanied by complications,mainly in the nose and pharynx. In the Tripolitania,blindness is the fate of 1 per cent. of the inhabi-

tants, and syphilis numbers nine-tenths of them amongits victims. The Ambulatorio Baccelli, divided, as stated,into four branches, meets this appalling state of things,first by its "general surgery" branch, which includes

obstetrics and gynaecology, under the direction of Dr.

BEVACQUA ; secondly, by its "general medicine" branch,under the eye of Dr. SCALESE ; thirdly, by its ’’ ophthalmic

"

branch, directed by Dr. Ezio MARRI and Dr. NOLA ; fourthly,and finally, by its "otorhinolaryngeal" branch, under thecontrol of Dr. ToNlETTi of Turin. Each branch has its

register of patients, from which details of other than medicalinterest may be drawn. The first applicants for relief werethe Jews, less distrustful than the Arabs, and therefore

profiting earlier by the gratuitous treatment which has

already wrought marvels on countenances horribly dis-

Bgured, in which the eyesight was often well-nighextinguished. These object-lessons in European thera-

peutics gradually attracted the Arabs, who began to throngthe previously unfrequented street and its Ambulatorio

Baccelli, their numbers increasing, as day by day therereturned to his friends a tribesman whose "bad eye" wasrestored to something like health and efficiency, the painrelieved by the appropriate collyria, and the whole systemfeeling the better for the treatment.

Eloquent indeed are the statistics of two months’ treatmentin the Ambulatorio. The otorhinolaryngeal branch had inthat period 444 new patients, with a total of 1423 visits ;while the registers numbered many operations, tracheotomyfor example, extirpation of tumours, and removal of polypi.In the " general medical " branch more than 1500 cases

were under treatment at the date of the last report,the ophthalmic branch recording an average of 100 visits

daily and the surgical an average of 40. The number

of eager applicants amount to a veritable " crowd,"impressed as they are by the resources of the pharmacyor drug store superintended by Dr. CREMISINI and its

continuous dispensing of gratuitous medicaments. Nay, asDr. ORAZIO PEDRAZZI, of the Subalpine School, in an ablereport points out, the Ambulatorio has a political import.ance not to be despised, the previously jealous, not to-

say hostile, natives coming to look on the invadingItalians as genuine benefactors whose presence among themmeans moral as well as physical rehabilitation. "Who,"asks Dr. PEDRAZZI, "would ever have expected that the-

jealous Arab women who, if met on the street, would hidetheir faces behind shawls or veils, would have dared to-

expose their breasts to the Italian physicians to get cured ofsome skin affection ‘! " Indeed, the "invisible girls," whofrom childhood are mewed up in their apartments to avoidthe public gaze, are brought by their mothers to the-

Ambulatorio, and while they hesitate to uncover themselves

they are reassured by the maternal voice and assisted by the-maternal hand, with the words, "Il medico 6 figlio di

Allah ! Gli occhi del medico non ricordano ! " ("The doctoris a son of Allah; the doctor’s eyes don’t remember ! ").Then the girls let their shawls drop and expose themselvesqa little coyly, to the profane onlooker, and when the-

diagnosis and the treatment are over their mothers addressthem : " Cbe Allah ti dia la salute dell’ anima come tu ci

dai quella del corpo " ("May Allah give you health of soul as

you give us health of body"). Truly a noble result of

medical effort. Medicine knows no politics, and whicheverside political right may be in the struggle in North Africascience cannot but rejoice in the good work being done byItaly, representing here European eivilisation and progress.

Medical Education and Practice andHome Rule.

THE Presidential Address of Sir DONALD MACALISTER to

the General Medical Council, whose summer meeting beganon Tuesday last, is published in another column, and doesnot foreshadow a lengthy sitting. Indeed, the meeting mayhave dissolved before many of our readers receive this paper.This is well, for, as we all know, the financial resources ofthe Council are strictly limited, and every economy which theofficials may strive to make is easily brought to no effect byan undue prolongation of the sitting. A highly important,

1553SEXUAL INSTRUCTION FOR CHILDREN.

though brief, debate has ensued in the Council upon the I

possible position of medicine, if and when the new (

Bill for the Government of Ireland becomes law. It t

is absolutely essential that such matters as medical educa-

tion, medical registration, and the supervision of the British

Pharmacopoeia should be reserved as specific matters to be dealt with by Imperial Parliament. We do not for a

moment suggest that any new Irish legislation would endeavour to set up a different system of medical registra- tion for Ireland, or to fix a degraded standard either of

examination or of education, but, as Sir CHARLES BALL

pointed out to the Council, it would be extremelyundesirable that any separation of the laws affecting thesematters should take place between Ireland and England andScotland. Sir DONALD MACALISTER supported Sir CHARLESBALL’S words by pointing out that if the Government of

Ireland Bill passed without any protective amendment onthe matter, it would be possible for the Irish legislatureto produce a medical enactment providing that no one

should practise medicine in Ireland who had not passedthe requisite examination in Ireland. The feeling of theCouncil was well expressed by the unanimous passage of

a resolution affirming that in the public interest and welfarea uniform standard of medical and dental education and

registration should be maintained in Great Britain and

Ireland. The resolution further provided that steps shouldbe taken to procure the insertion in the Government of

Ireland Bill now before Parliament provisions reserving tothe Imperial Parliament the control of legislation relating tothe Medical and Dentist Acts. With this attitude of the

General Medical Council all our readers will agree.

Annotations.

SEXUAL INSTRUCTION FOR CHILDREN.

II Ne quid nimis."

THE Instruction of the Young in Sexual Hygiene formed thesubject of an interesting communication by Dr. Eric Pritchardat the Conference of the Child-Study Society, held in theUniversity of London recently. Dr. Pritchard points out thathe used the term "sexual hygiene" as including "thosemany aspects of the sex question which have for their

common objective the scientific teaching of morality." It isno longer a matter of debate, he says, whether children shallreceive instruction on this subject ; the question is who is toteach them-how, when, and where. It is regarded as apostulate that children shall be told the truth, not neces-sarily the whole truth, but truth sufficient for their presentneeds and coordinated to their powers of understanding.Apart altogether from the undoubted fact that if such know-ledge is not properly imparted to children by proper personsit will inevitably be improperly thrust upon them from

polluted sources, comes now the comprehension that, thanks tothe findings and operations of psycho-analysis, we now knowthat the sexual life of children is much wider and richerthan it was formerly supposed to be, and that their relation-ships with others, their aversions, hatreds, joys and fearsare often swayed by that prime mover of our psychologicalactivities, the sexual instinct. It is not necessary to acceptunhesitatingly all the extreme doctrines that have been

advanced to accept this fundamental general principle. Dr.

Pritchard does not agree with those who consider that everychild should receive its first lesson in sexual knowledge fromthe mother, because mothers are for the most part absolutelyincompetent to convey this knowledge in a beneficial

manner; and, moreover, such a course in any case could beapplicable only in the case of the relatively small culturedclasses, and could not apply to the great masses who haveneither the understanding nor the education. He has no

great opinion of amateur work where professionals or expertscan be provided ; if children are to be taught such truths itshould be in the most skilful way and by the most competentteachers. The real obstacle in teaching the children theelements of sexual hygiene he considers to be the difficultyof effacing from our minds our own shame-faced conceptionsof these fundamental physiological truths consequent on ourinability to forget the impure sources of our own information.He suggests, therefore, the formation of societies for debateand discussion of these matters between parents and teachers,in whose syllabus of instruction lectures on sexual hygieneshould be included, and that the easy task should first beessayed of instructing young adolescents. Then as a know-

ledge of technical difficulties was gained and greater skill inthe practical teaching of details was acquired younger andyounger classes of children should in turn be undertaken,leaving "as little as possible to the parents, who havealready given abundant proofs of their willingness to shirkthis responsibility " and relying on expert knowledge andteaching. There is much sound wisdom and expediency inDr. Pritchard’s counsels.

__

A PLEA FOR THE WORD "MOCK,"

WHEN things are not what they seem, what more suitableword could be applied to them than "mock"? Prejudiceneed not be excited by the word, for mock-turtle soup,which everybody knows is not turtle soup, but a soup pre-pared from calf’s head in imitation of turtle soup, is verypopular. Modern times are full of mock things, but thesethings are described in a way which tries to convey, frequentlywith considerable success, that they are not "mock." In thisconnexion there is much in favour of the word being adaptedand adopted. It is plain, simple, and unmistakeable, andfreer from prejudice than are so many other words. How

much better, for example, would "mock-butter" be than"margarine" as a descriptive and discriminative term forthat substance, and why should mock-butter be a more dis-paraging title than mock-turtle ? As a matter of fact, mockpreparations can be mentioned which are dietetically as goodas the real preparation, if, indeed, in many instances theyare not better ; but let there be no deception about thematter. Mock-turtle is probably more nourishing than realturtle soup, and the various margarines show no dieteticinferiority to butter. Flavour is, of course, of importance,but as a rule the price for flavour is out of all proportion tothe intrinsic value of the food. If the word "mock" "

does not detract from the merits of mock-turtle whyshould its attachment discount the value or reputationof other articles of food or of drink or clothing. We have

already suggested mock-butter for margarine, and the idea.can obviously be extended. Mock-brandy could, for example,be applied to brandy that is not a product of the

grape or of a particular province ; mock-sardine to a fishthat is not, strictly speaking, a sardine ; mock-champagne toa wine which, though perfectly wholesome and a genuinewine, is not a product of the celebrated Champagne district ;mock-whisky to a spirit which is not an all-malt distillation ;mock-port to a wine which is not produced in Portugal,

though it may be a genuine wine and prepared in the same, way; mock-flannel to a fabric which is not flannel (a much

more straightforward name than flannelette). If the whole